I’d been telling her she needed health insurance since we first met. Something could happen. She’d been looking into options, but she never got sick. It didn’t seem urgent.

Then one morning she couldn’t pee. Nothing. She’d been trying since 3 a.m., and her bladder was full, but something was wrong. Urgent Care would open at 8 a.m., but by 6, her bladder was protruding from her belly and she needed to get to the hospital. At the emergency room, she was catheterized and waited while they conducted tests, but the doctor was mystified; he sent her home wearing a catheter and carrying a referral for a specialist. She paid cash on the way out.

And she kept paying cash, to all the specialists working to unravel her medical mystery. When it turned out that the problem was a volleyball-sized fibroid in her uterus that needed to come out—a full hysterectomy—cash was no longer an option. Moreover, her now pre-existing condition meant insurance wasn’t an option, either.

Guilt set in, followed by shame, followed by more guilt and more shame. She had meant to get insurance, but now she was the poster child for anti-Obamacare vitriol. Let them die, someone said on a talk show, referring to people in her situation. And she didn’t know how to respond. If only she’d gotten insurance. But chances are she would have been denied anyway, had a physical revealed her fibroid. And now, nobody would take her until the issue was resolved. The hysterectomy would cost at least $20,000, triple that if complications arose, as they had with a friend. The doctor said it was possible the fibroids had fused her organs.

She called insurance companies to see what, if anything, could be arranged. Then, someone mentioned the government’s Pre-Existing Condition Insurance Plan, part of the Affordable Care Act. She applied and got accepted. With the plan, she now pays $260 monthly, a $2,000 deductible and a co-insurance payment of up to $4,000. It’s costly, but she was relieved … until last week, when she and the rest of the country held their breath waiting to learn if the Supreme Court would strike down the Affordable Care Act. If it had, she would have likely gone deep into debt, possibly lost her home and been forced into bankruptcy, ultimately leaving someone else to pick up the tab. On Thursday, she celebrated the Supreme Court’s ruling by paying her insurance bill. Gratefully.